We are evaluating biomarkers in patients with severe infections that lead to shock and lung dysfunction. Samples are being analyzed in collaboration with collaborators at the University of Tennessee Memphis who have conducted a trial prospectively evaluatng the effects of corticosteroids on outcome from septic shock or severe respiratory failure. Our goals are to evaluate biomarkers at the time of study entry and during the course of the illness to determine if there are molecules that will help characterize the patients who are likely to have a beneficial response from corticosteroid therapy. During the last year we have screened 102 samples from patients with documented infection and ARDS for 14 chemokines, cytokines, hemostatic, and growth factors that have been suggested to play a role in the pathogenesis of lung injury. The effects of concurrent corticosteroid therapy on these mediators are being evaluated. A manuscript is in preparation.